See if you qualify for a $0 premium Essential Plan.
Essential Plan in New York
*A card that can be used to purchase over-the-counter (OTC) health-related items and food.
Which Essential Plan Do I Qualify For?
Depending on your income and other factors, you may be eligible for an Essential Plan with a $0 premium.
| Plan Features | Essential Plan 1 | Essential Plan 2 |
|---|---|---|
| Eligible Income Range | Based on your income and household size | Based on your income and household size |
| Max Income by Household Size | 1 person: up to $31,920 2 people: up to $43,280 3 people: up to $54,640 4 people: up to $66,000 | 1 person: up to $23,940 2 people: up to $32,460 3 people: up to $40,980 4 people: up to $49,500 |
| Eligible Age | 19 – 64 | 19 – 64 |
| Eligible EmblemHealth Service Area | You must live in one of the five boroughs of New York City or in Nassau, Suffolk, or Westchester county | You must live in one of the five boroughs of New York City or in Nassau, Suffolk, or Westchester county |
| Other Eligibility Requirements | Must be lawfully present in the United States | Must be lawfully present in the United States |
| Show More | ||
| Summary of Benefits and Coverage | View details | View details |
| Monthly Premium | $0 | $0 |
| Deductible | $0 | $0 |
| Maximum Out-of-Pocket | $360 | $200 |
| Preventive Care | Covered in full* | Covered in full* |
| Primary Care Provider (PCP) Visit | $15 copay | $0 copay |
| Specialist Visit | $25 copay | $0 copay |
| Outpatient Mental Health Visit | $15 copay | $0 copay |
| Urgent Care Visit | $25 copay | $0 copay |
| Emergency Room | $75 copay | $0 copay |
| Hospital Admission | $150 copay | $0 copay |
| Vision Care | $0 copay | $0 copay |
| Dental Care | $0 copay | $0 copay |
| Retail Prescription Drug Tier 1/2/3 | $6/$15/$30 copay | $1/$3/$3 copay |
| Mail Order Prescription Drug Tier 1/2/3 | $15/$37.50/$75 copay | $2.50/$7.50/$7.50 copay |
| Over-the-Counter Card | $125 per quarter | $125 per quarter |
| Gym Reimbursement | Covered | Covered |
| Maternity Care | Covered in full | Covered in full |
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| Plan Features | Essential Plan 3 | Essential Plan 4 |
|---|---|---|
| Eligible Income Range | Based on your income and household size | Based on your income and household size |
| Max Income by Household Size | 1 person: up to $22,025 2 people: up to $29,864 3 people: up to $37,702 4 people: up to $45,540 | 1 person: up to $15,960 2 people: up to $21,640 3 people: up to $27,320 4 people: up to $33,000 |
| Eligible Age | 21 – 64 | 21 – 64 |
| Eligible EmblemHealth Service Area | You must live in one of the five boroughs of New York City or in Nassau, Suffolk, or Westchester county | You must live in one of the five boroughs of New York City or in Nassau, Suffolk, or Westchester county |
| Other Eligibility Requirements | Must be a legally-residing immigrant | Must be a legally-residing immigrant |
| Show More | ||
| Summary of Benefits and Coverage | View details | View details |
| Monthly Premium | $0 | $0 |
| Deductible | $0 | $0 |
| Maximum Out-of-Pocket | $0 | $0 |
| Preventive Care | Covered in full* | Covered in full* |
| Primary Care Provider (PCP) Visit | $0 copay | $0 copay |
| Specialist Visit | $0 copay | $0 copay |
| Outpatient Mental Health Visit | $0 copay | $0 copay |
| Urgent Care Visit | $0 copay | $0 copay |
| Emergency Room | $0 copay | $0 copay |
| Hospital Admission | $0 copay | $0 copay |
| Vision Care | $0 copay | $0 copay |
| Dental Care | $0 copay | $0 copay |
| Retail Prescription Drug Tier 1/2/3 | $1/$3/$3 copay | $0/$0/$0 copay |
| Mail Order Prescription Drug Tier 1/2/3 | $2.50/$7.50/$7.50 copay | $0/$0/$0 copay |
| Over-the-Counter Card | $125 per quarter | $125 per quarter |
| Gym Reimbursement | Covered | Covered |
| Maternity Care | Covered in full | Covered in full |
| Show Less | ||
*Preventive services are not subject to cost-sharing (copayments, deductibles, or coinsurance) when performed by a network provider and provided in accordance with the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA), or if the items or services have an “A” or “B” rating from the U.S. Preventive Services Task Force (USPSTF), or if the immunizations are recommended by the Advisory Committee on Immunization Practices (ACIP), or when required by state law.
Eligibility depends on many factors, and it’s not always easy to figure out on your own. We can help you find out if you’re eligible and help you enroll.
Understand Your Network and Benefits
Explore tools and resources to find care, check your benefits, and get more from your coverage.
The EmblemHealth Difference
Your health depends on more than just going to the doctor. That’s why we offer additional programs, services, and support to help keep you feeling your best.
*Free, with no obligation to enroll.
**AdvantageCare Physicians (ACPNY) is an EmblemHealth company.
Check Your Eligibility and Get Help Enrolling
We can help you confirm eligibility, guide you through enrollment, and get the support you need in your language.
Already a member? Learn how to renew so you don’t lose your coverage.
Frequently Asked Questions
Get quick answers to your Essential Plan questions.
Eligibility for the Essential Plan is based on income, where you live, your citizenship/immigration status, and other factors. EmblemHealth can help you learn if you’re eligible and help enroll you in a plan if you are. Please contact our Essential Plan team at [VDNPHONE] (TTY: 711) to see if you qualify.
If you’re not eligible for the Essential Plan, you may qualify for one of our Medicaid plans. Visit our state-sponsored programs page to learn more.
The chart below shows the 2026 income limits for each Essential Plan based on household size. Eligibility is based on income, household size, age, residency, immigration status, and other factors.
Our team can help you find out if you qualify for the Essential Plan, explain your options, and guide you through enrollment. Call us at [VDNPHONE] (TTY: 711) for one-on-one support.
Maximum Income by Household Size
| Household Size | Essential Plan 1 Max Income | Essential Plan 2 Max Income | Essential Plan 3 Max Income | Essential Plan 4 Max Income |
|---|---|---|---|---|
| 1 person | $31,920 | $23,940 | $22,025 | $15,960 |
| 2 people | $43,280 | $32,460 | $29,864 | $21,640 |
| 3 people | $54,640 | $40,980 | $37,702 | $27,320 |
| 4 people | $66,000 | $49,500 | $45,540 | $33,000 |
| 5 people | $77,360 | $58,020 | $53,379 | $38,680 |
| 6 people | $88,720 | $66,540 | $61,217 | $44,360 |
| 7 people | $100,080 | $75,060 | $69,056 | $50,040 |
| 8 people | $111,440 | $83,580 | $76,894 | $55,720 |
Eligibility must be confirmed by NY State of Health.
Yes, Essential Plan 3 and 4 are available to legally-residing immigrants. During your enrollment process, you will need to provide documentation to support your legally-residing status. You can download a helpful checklist of documentation you may be asked to provide. For more information, contact [VDNPHONE] (TTY: 711).
Essential Plan members must renew their coverage every year. Visit our renewing coverage page for helpful resources, including a renewal checklist and short video on how to renew.
If you need assistance, we’re here to help. Call us at 888-432-8026 (TTY: 711) from 8 a.m. to 6 p.m., Monday through Friday. Prefer in-person support? Stop by or schedule an appointment at an EmblemHealth Neighborhood Care location near you.
The Essential Plan provides coverage for preventive care, mental health/substance use disorder services, lab services, ER visits, hospital stays, rehabilitative and habilitative services, prescription drugs, and more as required by the Affordable Care Act (ACA). Coverage for adult vision and dental care is also included.
Yes, if an Essential Plan member becomes pregnant or enrolls in the plan while they are pregnant, they will have coverage. If your Essential Plan includes cost-sharing for certain services, those will be waived during your pregnancy and 12-month postpartum period.
Please note: To report a pregnancy, call the NY State of Health at 855-355-5777 or sign in to your account at nystateofhealth.ny.gov. Newborns need to be enrolled in Medicaid before or shortly after their birth, as coverage for children under the age of 19 is not available through the Essential Plan.
EmblemHealth’s Enhanced Care network is designed to offer access to top providers where you live and work. The Essential Plan offers in-network coverage only. Members who receive out-of-network services are responsible for the full cost of such care, except in the case of a medical emergency.
Use the FAIR Health Calculator* to estimate the cost of nonemergency medical services and procedures by ZIP code.
*FAIR Health, Inc. is an independent nonprofit organization that uses actual provider charges when calculating fees. FAIR Health ensures that its fee information is accurate and complete. Please review the privacy policy and terms and conditions on the FAIR Health website.
You have a few ways to learn more:
- Call our Essential Plan team at [VDNPHONE] (TTY: 711) for one-on-one support. We can help you check your eligibility, understand your options, and get started.
- Download our Free Guide to get an overview of the Essential Plan and other individual and family plans.
- Use our Shop and Compare tool to explore plan options and see what may fit your needs.
- Visit the NY State of Health website to get official program information.